Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT R men Permit#: MEC2021-00839
Date Issued: 10/19/2021
13125 SW Hall Blvd.,Tigard OR 97223 503.718.24392- I Parcel: 2S102BC00107
Jurisdiction: Tigard
Site address: 10295 SW BROOKSIDE CT
Project: Brookside Subdivision: WALNUT ACRES Lot: 6
Project Description: Replace Furnace and AC.2/17/22: REPRINTED to add(1)range hood,(1)clothes dryer exhaust,and(3)single
duct exhaust.
Contractor: CLEARY AIR Owner: SAMSON CONSULTING LLC
31010 NW COMMERCIAL ST 11640 SW TERRACE TRAILS DR
NORTH PLAINS, OR 97133 TIGARD, OR 97223
PHONE: 503-989-5251 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 10/19/2021 $46.75
Type of Use: SF Furnaces< 100K BTU 10/19/2021 $46.75
Class of Work: ALT Type of Const: Range Hood/Other Kitchen 0211612022 $33.39
Occupancy Grp: Clothes Dryer Exhaust 02/16/2022 $33.39
Stories: Single Duct Exhaust(Bathrooms,Toilet, 02/16/2022 $69.96
Utility Rooms)
12%State Surcharge-Mechanical 02/16/2022 $27.63
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $257.87
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: �l' 4i Q 4 Permittee Signature: ai(�(��;
��1444 �p ` I"
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Avolication
City of TigardQPCEIVED p L.I��y12�_ Rmuka _
13125 5W I(all Blvd-. t Wd.U 9 Pba Bnuw
Plumb ', 1W Ir2439 Fox. 503.5991460 l7rtc Uv.. prime Pumir
lmsprcti.m Lilts: 3!13..6391175 FEB 14 2022 -- -- - - -.- - -
Internet viYv FllJatd Srr guy Usle Nr:ir n. /a. W See Yayr l for -- - -
Nkeldicd,Mclhua: ti1(p122 rmplitmeo lIO&MIdn
GI7Y OF TIGHK� �QI�-�?.
T"F ORMORG DIVISIOF, CQMMUKUR,1U•,IMEMULE—LUctiWnw
---- Plrchmir:al permie fm•art btatd Inl ehe vdue ofthe warn
Q Vax rollslr xuua Ad litiul n l.rnunn rc[i4yce Hent Perfy7ned 1rWlealc the value Irourijed W dwe(kar�l dltllrl lif all
❑Lscatolitism ❑i)IJlez: mechmical mmaridl-.�ipmmsm.Ichor.mtctlicad,and pLoM
CAT@CiORY t0i`OUNSrt1UCR'IpY RLNi:-%MALEQRnPMe.VrrSYMM IF
OV
(�-and 2-rarnil}dyt'alline ❑(:cnitrnt�cial'indu�[rial I]ALc�IF) building Far gwddlmfcrww hw mcchenFAM
❑Mune-l;miily ❑h•la3ter hui11}cr ❑lMlser. IleK=sptial —fITw1-(�. Fit Tcusl
jcp
9rFx Q'ik'dRMA1'1C)IN Arm LOCA41m pealiapltraal;4c
Jit ai trex: `••�- Air cmdltlortlirtg
3i c I
,�.Z-rj S�"3 (--:1 dnw lata plan shmiat IILI l au 403
Fumaw 1(1!,(1110 HT1J AKis,xml } 4675
furnaua 1(11,0(10^Hit'Idrmt--.-=.veOIs�: 51,91
5stiteroldg.�apf na: Pr"M"wft-.-. I lam ptanP
nrp dk nMn allm i u rdxnr nn1 61.(16
Gust::streat+directionstojm6site: Uw:iwat _ � 2332
TbAA ,ry l -•7 Ifi"iuhutxarcvs)%lem 2332
rCS ►t V I+t [ _S Y lk lidcntial Tmwhr[radimta ce
rn monist a332
—••---- lilvit icetdeti!Joel-type.nut deeurie),
ni-xall,inAka SUJ22a2!n de 46 15
Sabdiyislun. Fluurxrafmwn01 &Wye 2332
� 1 cq rets.:
(Alter: 2332
1 wx rrsVf T'Orpel mi.; Raker W a ►mtx
! a-
DMCt6WON OF wMw u'mer heeler 23.32
n(� JJ.. , Cas fi lace 33.39
t"f'h'�i �AITO "' DC J � F7uevtMrk avatar!rosesnrgmF
TO t--Y,h IJ�tI ytel`.{tF �2flr(1 fireplwe 23.32
Lax kiphecr(its) 23.32
., W.00dipetl6 MAV 3339
.wlxid ftreplau;.'inxn 23.32
❑ T1R R7 03Aq(CR ' u 13 y`P,NA7eTClvr rxst9ircr Oue t Ont 3.32
(hlttt 23.32
lrart.r- Cmyin mmmmtal rskmmsl Red ytalihjkia:
Adrlrexy: ^rte-u&T kmdsm , . 3339
Cin+Sld(aLIP: Ot4hes cicOmmi y 3339
4igyk Aio edmust(baMrmmt, 7
PMttia I 1 Fax.( I Wikt cum ttmatw,usllwy ro mtli) 2332 1 y
WAPPLNCAN1 ❑Ct 4iiiC'r-PLR5m I Anil'ttmulstram fans 2332
Buailw-as Itnlrtc: (�s L,4,'-y.Al _ fr+ I other -- 2332
----4Fiel _
C'skMtict nntnm: .vim_J�4,y?r c.T W15 for ilrxt pour;S1.I0 W retch adtkmz
Addrr : Fumre.nc
(lal hes rmim
e'hy1'State.7.IP: (t tt a s Q � j'j, W4lFsus �tmlt[m-ster
Phtxte:(QJC5 ) 7 rZ C"1 Fax::( 1 15aer heeler
l:-Ismil: � " µ Ftrcdlil-r
KAFWX
CONTA4CM BprbMve
ausi d Hutu:: C M.S drier(raa—t.
1lddrc5F: —�+ Ther- I
MIUMA"C:ALPCRMITIrL6S*
Mitmmurn pmnil feu IS9fi 0(11
Phcmlr. I I Fax'( 1 Yon tryy'x(2 t4of ermic I'ee>
CCH lie
Starr ra Thorp(121.4 of Praralt lee)
'rUTAI.Pr.RMIT FEE:
AuffiMAod i rre' TM pw"A appbcamm espirss if a pnmk wtum ebtalned ri1161a In
dais afar it hes beteg aacepled ft m pts.
Print nanx: 01s1s -r u.~ iv a.ew.lp.J,1Fy sn bl rnl uunl feietdme udug}5elskr A...1d
r murtq 1w ulfiT'Mn.beds.3.+11 Yi ��' 411 H.I'I 111.^frlhrHLH,